Author(s): SHIVGULAM, M., SAUCIER, D., ALLAIN, J., DUMONT, M., AHMADI, S., BARRIEAU, L., CORMIER, L., THEOU, O., MEKARI, S., O'BRIEN, M., Institution: CENTRE DE FORMATION MÉDICALE DU NOUVEAU-BRUNSWICK, Country: CANADA, Abstract-ID: 2498

INTRODUCTION:
Hospitalized older adults spend most of their time non-upright (sitting, reclining, or lying), which may contribute to functional decline. Physical activity and postures during hospitalization are not well characterized. It is plausible that activity patterns during hospitalization differ according to baseline frailty, a multidimensional metric of physiological vulnerability. We tested if upright time would increase, and non-upright time would decrease over the course of hospitalization, and if these changes would be greater among those with higher baseline frailty.
METHODS:
Sixteen patients (age: 71±12 [range: 52-91] years, 8 females) from an internal medicine unit receiving usual care, including 1 visit/d from a Kinesiologist, who wore an activPAL for at least 3-d were included. All participants were equipped with an activPAL on their thigh 24 h/d throughout unit admission to measure upright and nonupright activities. Frailty was assessed using a validated 65 item index two weeks prior to admission (retrospectively), at admission, and at unit discharge. For each participant, valid monitoring days were divided into tertiles representing early, mid, and late hospitalization. Mean activity outcomes were calculated within each tertile, and tertiles 1 and 3 were compared.
RESULTS:
Prior to hospitalization patients could walk independently (n=6), with an aid (n=7), or with the assistance of another person (n=3). Mean length of stay was 12±10 (range: 3-38) days. Those with baseline frailty indices ≥0.30 (n=8) were older (79±11 vs 64±9 years) and had a larger proportion of those who required an aid (n=6 vs n=1 ) or another person to help them walk (n=2 vs n=1) (p=0.01), but had similar sex distribution (5 vs 3 females, p=0.62) and length of stay (9.4±5.6 vs 15.2±13.6 days, p=0.46) compared to those with frailty indices <0.30 (n=8). Frailty did not change across pre-admission, admission, and discharge among those with frailty <0.3 (0.19±0.10 vs 0.19±0.08 vs 0.19±0.11, p=0.99) or ≥0.3 (0.38±0.09 vs 0.41±0.07 vs 0.41±0.03, p=0.50). Among those with baseline frailty <0.30, there was no change in steps (870±777 to 1538±1280 steps/d), standing (50±37 to 73±55 min/d), upright time (62±44 to 92±69 min/d), sit-to-stand transitions (23±13 to 31±19 transitions/d), or non-upright time (23.0±0.7 to 22.5±1.2 h/d) between tertile 1 and tertile 3 (all, p>0.08). Among those with frailty ≥0.30, upright time (20±24 to 38±38 min/d) including steps (72±130 to 172±180 steps/d) and standing (18±22 to 35±36 min/d) increased and non-upright time decreased (23.7±0.4 to 23.4±0.6 h/d) between tertile 1 and tertile 3 (all, p>0.04). However, there were no changes in sit-to-stand transitions (14±9 to 18±9 transitions/d, p=0.24).
CONCLUSION:
In acute care, patients accumulate >23 h/d non-upright and <200 steps/d. Patients who have higher frailty at admission demonstrate increases in activity across hospitalization with daily intervention from a Kinesiologist, although overall activity levels remain extremely low.